Employer Survey

Please help us by taking this short survey. Your responses are 100% confidential. We will compile the results to gain insight into the prescription drug issue, to identify future learning opportunities and to determine additional resources valuable for this site.

1. Gender

2. Age

3. Ethnicity

4. Zip Code

5. What is your type of business activity? (Select the option that contributes most toward your gross sales.)

6. Prescription drug abuse is a problem in our country.

7. Prescription drug abuse is a problem in my workforce.

8. At some point, the misuse of a prescription drugs adversely impacted my work performance or that of someone close to me.